ED Caused by Intestinal Issues Can Be Difficult to Stomach

Nobody feels sexy when they're having stomach issues. If you're perpetually on the verge of running to the toilet, it's tricky at best to spring into action with your partner.

For people with chronic gut issues such as irritable bowel syndrome (IBS) or inflammatory bowel disease (IBD), having sex can present a seemingly insurmountable challenge.

So it's little wonder that some men with these conditions might experience erectile dysfunction (ED) that's at least partly psychologically based, technically referred to as psychogenic ED. Some men with IBS or IBD report avoiding sex altogether rather than facing the possibility of embarrassment.

But recent studies reveal that the connection between ED and bowel issues such as IBD and IBS may run much deeper. In some cases, these bowel conditions may be at least partially to blame for not only psychogenic ED but also organic ED, or ED stemming from physical causes.

What are IBD and IBS?

While both IBD and IBS affect the digestive system and the bowels in particular, important differences between the two exist.

IBD is a structural disease that involves the chronic inflammation of the bowels and encompasses conditions including Crohn's disease and ulcerative colitis. These are lifelong conditions that involve inflammation of the mucosal layers of the colon and sometimes other parts of the digestive tract.

IBS, on the other hand, is a functional disease of the bowels that doesn't always have a clear underlying cause. Ongoing research is seeking a link between IBS and gluten intolerance and other food-related issues, but nothing conclusive has been proved.

Both conditions can present similar symptoms:

• Diarrhea
• Cramps
• Abdominal pains
• Urgent need to poop
• Constipation

The ED connection

While it's tempting and certainly not illogical to suggest that most men with IBS or IBD who also suffer from ED may face more of a psychogenic version of the condition, some recent studies say organic ED is just as likely.

One groundbreaking Taiwanese study published in the International Journal of Impotence Research in 2015 looked at data on 15,533 IBS patients and the incidence of both psychogenic ED and organic ED. The results showed that men with IBS were 2.38 times more likely to develop psychogenic ED than men without IBS. However, the IBS men were also more than twice as likely to develop organic ED.

One large-scale review of studies published in 2019 in the Sexual Medicine journal found a correlation between IBS and sexual dysfunction in men and women, though researchers acknowledged that more investigation was required. They also pointed to previous studies showing a higher occurrence of sexual dysfunction in patients suffering from IBD.

The 2019 review didn't explain the link between sexual dysfunction and bowel issues, apart from offering anecdotal confirmation that symptoms such as flatulence, bloating, soiling and abdominal pain can impact a person's sex life. Some patients said bowel problems made sexual activity difficult or reduced their sexual desire.

Some hypotheses

The authors of the Taiwanese study referred to previous theories about the factors connecting IBS and ED, including a serotonin imbalance and an imbalance of cytokines, which are proteins known to inhibit the availability of nitric oxide—a necessary component of an erection—as well as being a mechanism of IBS.

Another hypothesis noted that while psychogenic causes of ED include stress, anxiety and depression, these conditions were also significantly more common in men with IBS. The authors also noted that stress could increase the gastrin-releasing peptide level in the stomach, which might stimulate the release of cortisol—the "stress hormone" that plays a role in inhibiting erections. In other words, the stress of IBS could induce ED.

Suffice to say, more work is required to find organic links between IBS, IBD and ED.

Considering all the treatment options available for each condition, as well as the psychological boost for men knowing that their ED may be, at least in part, fueled by physical problems related to their IBS, there is certainly reason for hope.